What Do You Want to Know About Parkinson's Disease?

Parkinson’s disease (PD) is a progressive neurological disorder. It first presents with problems of movement. There’s no cure for PD. This disorder is chronic and worsens over time.

Smooth and coordinated muscle movements of the body are made possible
by a substance in the brain called dopamine. Dopamine is produced in a
part of the brain called the “substantia nigra.” In PD, the cells of
the substantia nigra start to die. When this happens, dopamine levels
are reduced. When they have dropped 60 to 80 percent, symptoms of PD
start to appear.

More than 50,000 new cases are reported in the U.S. each year. The
actual incidence may be even higher, since PD is often misdiagnosed. The
Center of Disease Control and Prevention’s National Center for Health
Statistics reports that PD complications are the 14th major cause of
death in the United States. (CDC)

Causes of Parkinson’s Disease

The exact cause of PD is unknown. It may have both genetic and
environmental components. Some scientists think that viruses can
trigger PD as well.

Low levels of dopamine and norepinephrine, a substance that
regulates dopamine, have been linked with PD. Abnormal proteins called
Lewy bodies have also been found in the brains of people with PD.
Scientists do not know what role, if any, Lewy bodies play a role in
the development of PD.

Risk Factors for Parkinson’s Disease

Certain groups of people have an increased risk of PD.

Men are one and a half times more likely to get PD than women.

Whites are more likely to get PD than African-Americans or Asians.

PD usually appears between the ages of 50 and 60. It only occurs
before the age of 40 in five to 10 percent of cases. People with a
family history are more likely to develop this disorder.

Symptoms of Parkinson’s Disease

Some of the earliest symptoms of PD are decreased ability to smell
(anosmia) and constipation. These symptoms can precede motor problems
by several years.

The four major motor problems seen in PD are:

tremor—shaking that occurs at rest

slow movements

stiffness of arms, legs, and trunk

problems with balance and tendency to fall

Secondary symptoms of PD include:

blank facial expression

a tendency to get stuck when walking

small, cramped handwriting

muffled, low-volume speech

decreased blinking and swallowing

tendency to fall backwards

reduced arm swinging when walking

Other, more extreme, symptoms of PD are:

flaky white or yellow scales on oily parts of the skin, known as seborrheic dermatitis

Diagnosing Parkinson’s Disease

There is no specific test for PD. Diagnosis is made based on health
history and a physical and neurological exam. Tests such as CAT scan or
MRI may be used to rule out other conditions.

Treatments for Parkinson’s Disease

Adequate rest, exercise, and a balanced diet are important. Speech
therapy, occupational therapy, and physical therapy can also help to
improve communication and self care.

Surgical interventions are reserved for people who don’t respond to
medication, therapy, and lifestyle changes. So are procedures such as
deep brain stimulation (DBS).

In almost all cases of PD, medication will be required to help
control the various physical and mental health symptoms associated with
the disease.

Drugs and Medication Used to Treat Parkinson’s Disease

A number of different drugs can be used to treat PD.

Levodopa

Levodopais the most common treatment for PD. It
helps to replenish dopamine. About 75 percent of cases respond to
levodopa, but not all symptoms are improved. Levodopa
is generally given with carbidopa. Carbidopa delays the breakdown of
levodopa which in turn increases the availability of levodopa at the
blood-brain barrier.

Dopamine Agonists

Dopamine agonistscan imitate the action of dopamine in the brain.
Dopamine agonists are less effective than levodopa. However, they can
be useful as bridge medications when levodopa is less effective. Drugs
in this class include bromocriptine, pramipexole, and ropinirole.

Anticholinergics

Anticholinergicsare used to block the
parasympathetic nervous system. They can help with rigidity. Side
effects may include impaired memory, dry eyes, dry mouth, and
constipation. Benztropine (Cogentin) and trihexyphenidyl are
anticholinergics used to treat PD.

Amantadine (Symmetrel)

Amantadine (Symmetrel) can be used along with carbidopa-levodopa. It is a glutamate blocking drug (NMDA). It
offers short-term relief for the involuntary movements (dyskinesia)
that can be a side effect of levodopa. Side effects of amantadine
include hallucinations and patchy skin color.

COMT Inhibitors

Catechol O-methyltransferase (COMT) inhibitorsprolong the effect of
levodopa. Entacapone (Comtan) and tolcapone (Tasmar) are examples of
COMT inhibitors. Tolcapone can cause liver damage. It is usually saved
for patients who don’t respond to other therapies. Ectacapone doesn’t
cause liver damage. Stalevo is a drug that combines ectacapone and
carbidopa-levodopa in one pill.

MAO B Inhibitors

MAO B inhibitorsinhibit the enzyme monoamine oxidase B. This enzyme
breaks down dopamine in the brain. Side effects don’t occur often, but
they can include headache, dizziness, confusion, and hallucinations.
Selegiline (Eldepryl) and rasagiline (Azilect) are examples of MAO B
inhibitors. Talk with your doctor before taking any other medications
with MAO B inhibitors. They can interact with many drugs, including:

antidepressants

ciprofloxacin

St. John’s wort

some narcotics

Over time, the effectiveness of PD medications can decrease. However, they may still provide adequate control of symptoms.

What You Can Do at Home

People with PD have problems with activities of daily living.
Doctors at the Mayo Clinic have recommended a number of very simple
steps to help patients with PD move around and walk more safely.

To improve walking:

Walk carefully.

Pace yourself – try not to move too quickly.

Let your heel hit the floor first.

Check your posture and stand up straight. This will help you to shuffle less.

To avoid falling:

Don’t walk backwards.

Try to not carry things while walking.

Try to avoid leaning and reaching.

To turn around, make a U-turn. Don’t pivot on your feet.

When getting dressed:

Allow yourself plenty of time to get ready. Avoid rushing.

Select clothes that are easy to put on and take off.

Try using items with velcro instead of buttons.

Try wearing pants and skirts with elastic waist bands. These may be easier than buttons and zippers.

Because it's a progressive disease, identifying Parkinson's early can help treatment. Early signs of Parkinson’s disease can be easy to miss, but if you notice these signs, it may be time to see a doctor.

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